We do the antigen testing for units ordered from our blood service. We have found units that were supposedly negative for an antigen but actually positive. We also are required by our computer system to enter the antigen testing results for a unit before it will allow the selection of that unit to a patient with the corresponding antibody.

We (the Blood Bank) evaluate for Rh Immune Globulin at our facility. Since we issue, deliver the Rh Immune Globulin to the floor and do the FMH testing (we also have the KB results from our Hematology Department), we issue the appropriate amount of Rh Immune Globulin syringes to be taken to the floor (based on KB results).

We do not notify our medical director. We alert the nurse taking care of the patient that more than 1 vial of Rh Immune Globulin is needed due to a positive FMH. The KB results are on the chart also. The nurses inform the patient's physicians.

Our pathologist (Blood Bank Medical Director) wants to approve each case of transfusing least incompatible units. He will often speak with the ordering physician to discuss benefits vs. risks involved. Once he has approved the transfusion of least incompatible for that patient, we do not need further approval unless something changes. So far, in my career, these patients have never reacted to the transfused blood. Usually, they were already hemolyzing their own blood and needed transfusion to correct very critically low H & H's.

I just have a hard time transfusing red cells that yield a 1-2+ positive reaction at immediate spin (can't call that compatible :o) ). That being said, we do what our pathologist requires. I agree that O mothers delivering incompatible type babies have destructive IgG ABO antibodies. We still do Lui Freeze Elutions on all neonates with positive DAT's to identify the "culprit" antibody. I'm not sure many facilities continue to do that.
Thanks for the references.

I would worry more about the Anti-A1 antibody than the low amount of Anti-A in the residual plasma of a B unit of packed cells. If the Anti-A1 is present at immediate spin, then it is probably IgM just like Anti-A and Anti-B that are naturally occurring (which cause HTR). We see these individuals occasionally and transfuse them with O blood (if it is an A subgroup with Anti-A1 antibody) and with B blood if its an A subgroup B individual with Anti-A1. The transfusions are successful. I worry more about having to give type incompatible platelets that have way more plasma than a unit of packed cells.

No, Malcolm, we aren't! We are prehistoric but not that prehistoric! Ha! Just a 1 tube (glass tube, by the way) enhanced with LISS (Immucor ImmuAdd) and AHG. We also do crossmatches on the Immucor Galileo Echo.